A number of epidemiological studies have reported an association between serum uric acid (SUA) levels and a wide variety of high-risk conditions including hypertension, insulin resistance, kidney and cerebro-cardiovascular diseases. Moreover, the sharp rise in the prevalence of these conditions has also been associated with a progressive rise in SUA levels in the general population (from less than 3.5 mg/dL in the 1920s to 6.5 mg/dL in the 1970s). In this article we critically analyze whether SUA plays an active role in the development of atherosclerotic damage or should be considered an innocent bystander. Although the treatment of asymptomatic hyperuricemia is not yet recommended for the primary prevention of cardiovascular diseases, recent studies suggest a direct relationship between pharmacological reduction of SUA and cardiovascular and renal protection.
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